If you’re scratching your head wondering what I’m talking about, this article may not be for you.
But if you see a flash of problems across your minds’ eye, read on… because this is for you!
Headaches, obstacles, problems, challenges, opportunities…
Whatever you call them, if you’ve been in practice for any length of time, you’ve been up against them.
Of course, every situation, clinic, and provider is different. However, there are core “challenges” experienced universally by most practice owners.
So what are these challenges?
- Getting paid for your work from insurance and patients.
- Getting and staying credentialed.
- Creating consistent and reliable cash flow in your practice.
If you neglect to focus on any of these challenges, each one can put significant hurdles in your way.
Let me point out they don’t exist in a vacuum; to some degree, they’re all interconnected.
What do I mean?
- Getting paid… if you don’t get paid for your work, your cash flow will suffer, and you won’t be able to stay in practice for long. And it doesn’t matter if you’re an all-cash practice or credentialed with insurance.
- Creating consistent cash flow… late or no reimbursements/payments, translate into roller coaster cash flow, leaving you wondering how to pay bills from month to month.
- Getting credentialed… if you have problems getting or staying credentialed, you may lose valuable time, income, and patients. Additionally, you may end up paying expensive fees, when you could do it yourself.
Every one of these challenges has the power to make or break your practice!
So over the next few weeks, we’ll tackle all three challenges, one by one.
Today, let’s begin with talking about getting paid… this may be the biggest challenge of them all!
Headache #1 Getting Paid
You are a practice owner; to you, collecting a paycheck is a thing of the past.
Today, your “paycheck” comes from money you collect from patients and the reimbursements you get from insurance companies. So it’s alarming when they don’t pay on time, or don’t pay at all.
But as a health care provider, you find yourself surrounded by a unique set of circumstances.
Health care in America is getting more and more expensive. And consequently, even insured Americans report difficulty affording health care or keeping up with out of pocket costs.
Collecting Patient Responsibility
More and more patients have bigger co-pays, higher coinsurance, and sky-high deductibles. And if your practice fails to or falls behind collecting on patient responsibility, you could lose thousands of dollars every year.
What can you do?
Train your staff…
You must train your staff, so they apply your strategies and collect patient responsibility at the time of service. Because the more time elapses between service and payment, the less likely you will see any money at all.
Train your patients…
Next, you must train your patients. It’s important that patients understand their responsibility to pay at the time of service, every time.
Unfortunately, for many providers and their staff talking about money is uncomfortable. Never mind asking for money right after a patient has said they can’t afford to pay…
That’s why all too often, these conversations never take place. But unless you get past your discomfort, getting patients to pay may remain a challenge for you.
If patients have difficulty paying their responsibility, you may be tempted to help by offering a payment plan. But remember, you are not in the business of extending credit; that’s what credit card companies do.
And finally, if someone doesn’t want to pay, don’t be afraid to turn the account over to collections. If interested, you can learn more about these strategies here.
Now, what about insurance companies? What can you do to reduce claim rejections and denials, thereby improving your reimbursements?
At first glance, it might seem difficult, perhaps even impossible…
Because let’s face it, insurance companies are not in business to pay out claims all day long! That’s not their primary business model.
This may be shocking….
But like every other business, insurance companies are in business to turn a profit.
To that end, they will deny any claim they legitimately can deny. And sadly, that’s why they won’t think twice leaving you holding the bag.
Of course, they pay out plenty of claims. But they’ll also go to great length to make sure they pay out as little as possible.
I know it sounds harsh, but it’s the truth.
But here’s the takeaway…
It’s your responsibility! Yes, it’s up to you to know how to work with insurance companies effectively, that is if you want to get paid!
After all, you’re on their playground, and regardless if you realize it or not, you’re playing by their rules.
So, if you want to beat them at their own game and get paid for the work you do, you must improve your understanding of how insurance works.
You must understand their process, speak their language, and understand how they think.
Because every claim that gets rejected or denied, chips away at your bottom line. And you know if you don’t get his right, you won’t be able to keep your doors open for long.
So here are some questions to ask yourself…
- Do you fully understand the insurance process from A through Z?
- Are you comfortable with insurance terminology?
- Do you use the correct terms when working with insurance and patients?
- Do you understand the importance of your payer mix and denial mix?
- Do you have the proper documentation to support your coding?
- Do you know how to code for services beyond basic E&M codes?
- Do you understand the billing process, from start to finish?
- Do you understand when to use an informational or a pricing modifier?
- Do you know how to scan for common billing errors to make corrections before submitting a claim?
- Do you understand your EOBs and ERAs and do you know how to use them for your benefit?
If you’re comfortable answering the above question, fantastic.
But if not, focus on improving your understanding so that you can get better results when working with insurance.
Improving your understanding of the insurance process… then implementing, is vital to the success of your practice.
It’s knowledge that may give you the biggest return on investment!
Have you experienced problems with getting paid? Share your experience, let us know, and leave a comment!
By Johanna Hofmann, MBA, LAc; regular contributor to the NPBusiness blog and author of “Smart Business Planning for Clinicians.“